Dual Diagnosis: PTSD
Mental health can suffer greatly following a traumatic event, with approximately 1 in 3 individuals developing Post-Traumatic Stress Disorder (PTSD) after experiencing trauma1.
Self-medicating with alcohol and drugs is often seen amongst people with PTSD, and so when seeking treatment for addiction, it is most beneficial to treat the co-occurring PTSD at the same time.
How is PTSD and Substance Abuse Connected?
A dual diagnosis of substance addiction and PTSD is, sadly, very common. Numbers are particularly high among those who have served in the military, with around 75% of veterans with PTSD also suffering from alcohol dependence. Comparatively, up to 43% of civilians who have PTSD report co-occurring substance use disorders2.
While it has been found that many people with PTSD self-medicate with drugs and alcohol, research also suggests that people with existing substance use disorders are more likely to experience traumatic events and later develop PTSD3. The relationship between these two disorders is therefore undeniable.
The signs of PTSD vary from person to person and can take months or even years to develop, so it is not always obvious that the symptoms are rooted in trauma. Symptoms include:
- Anxiety
- Depression
- Insomnia
- Frequent nightmares or flashbacks
- Irritability
- Suicidal thoughts
While prescription medication is often used to combat the symptoms of PTSD, many people do not seek medical support, and instead, try to ease them with alcohol or recreational drugs.
Veterans, in particular, are less likely to seek formal treatment for anxiety or depression, often feeling that they simply need to ‘toughen up’. In reality, the only way to truly overcome trauma and beat PTSD is through emotional support, and this often requires therapy.
Causes of PTSD and Substance Use Disorders
People can experience depression, anxiety and stress even if they have not been exposed to traumatic events, and so anyone can develop a substance use disorder. However, when PTSD and substance abuse are co-occurring, a crucial element of treatment planning is to analyse the trauma and work towards it.
Examples of traumatic events that can result in PTSD include:
- Loss, including death and divorce
- Military experience
- Serious accidents
- Childhood trauma
- Neglect
- Experiencing a natural disaster
- Abuse
- Bullying
PTSD can be caused by a single traumatic incident, or from repeated harmful or dangerous occurrences. Certain occupations make people more prone to being exposed to dangerous situations, including paramedics, doctors, veterans, and firefighters.
It is no surprise then that the incidence of alcoholism in certain professions is often higher than that in the general population. Strikingly, it is those in the mining industry – which involves working long, often irregular shifts in perilous conditions – who reported the highest rates of heavy drinking of any occupation, at 17.5%4.
PTSD tends to exaggerate the ‘fight-or-flight response in those affected, and so can be especially devastating for those who work in high-risk jobs. People with PTSD who work in stressful jobs have therefore been known to rely on liquid courage to help steel their nerves.
This can easily get out of hand and develop into an addiction, so anyone who suspects that they might have PTSD, or is currently using alcohol or recreational drugs to manage symptoms, should speak to their GP about getting started with proper treatment.
Why Self-Medicating for PTSD is Harmful
Many people with substance use disorders first turn to alcohol in order to distract themselves or ease the pain during an upsetting time.
Events like the death of a loved one or losing a job are often marked with commiserative drinks, which are fine in moderation. However, regularly drinking in order to alleviate negative feelings can lead to an alcohol dependency.
Most importantly, self-medicating in any way does not remove the cause of the pain. At best, it provides temporary numbing, and should never be used as an alternative to proper therapy and mental health support.
Unfortunately, once someone has decided to try to handle the symptoms on their own, their emotional problems can worsen, and they may become even more resistant to offers of help.
The numbing effects of alcohol may feel comforting to them, and so it can be difficult to convince them that what they are doing is harmful.
Because alcohol is a depressant, abusing it can actually make the symptoms of PTSD even worse and, as someone builds up tolerances, the individual might think that they need to drink more in order to feel better.
With increased substance use, the chances of addiction and subsequent health problems also increase.
Health problems associated with alcohol or drug addiction include:
- Heart disease
- Stroke
- Cancer
- Hepatitis B and C
- Mood disorders
- Liver disease
- Complications from overdosing, including death
Getting Help for PTSD and Substance Use Disorders
People who suffer from post-traumatic stress disorder are often seeking immediate relief and comfort, which is why so many turn to substances like alcohol and drugs. At best, these offer only temporary relief; at worst, they can lead to a lifelong relationship with harmful substances.
The good news is that healthy and long-lasting solutions can be accessed by simply talking with your GP, or with a rehabilitation consultant.
Most people with PTSD and a co-occurring addiction will be advised to seek treatment at a rehabilitation centre. Because the relationship between PTSD and substance use is so well-documented, many addiction treatment centres are experienced in combating both issues together.
Even if PTSD is what has caused the substance use disorder, a treatment that only focuses on tackling the signs of PTSD is often not enough to stop the resulting addiction.
Rehabilitation centres can be accessed privately or via the NHS, but the latter will require a referral from your GP and can take some time. If you aren’t sure which is the right path for you, being open and honest with your GP is key.
If you feel more comfortable discussing it with a stranger – as many do – then many private centres offer free and confidential advice via telephone.
If you have had a dual diagnosis of PTSD and a substance use disorder, it is crucial that you seek out an effective treatment programme as quickly as possible. Both PTSD and substance use can affect motivation, and it can often be easy to get comfortable in a bad situation.
Treatment for a dual diagnosis of PTSD and substance use usually involves prescribed medication to control a chemical detox, as well as mental health therapy to process the underlying trauma.
Treatments for PTSD and Substance Use
Below, we discuss a number of common treatments for PTSD and substance use disorders:
1. Detox
Detox is often required when someone has been abusing a particular substance for a long time, and their body has developed physical dependence. Some people who have only recently begun to self-medicate for PTSD may not need to detox, and it might be safe for them to simply stop cold turkey.
However, chemical dependency can affect our perspectives, and convince us that we are in a better position than we really are.
Therefore, a decision on whether or not to undergo a medically-assisted detox must only be made following a conversation with your GP or an addiction specialist.
Detox is typically the first step in any addiction treatment plan, as some substances can dilute or counteract the effects of any supportive medications that might be prescribed.
2. Medication
The psychological effects of both PTSD and alcoholism or drug use can be devastating. Depression, anxiety, poor impulse control, and rapid mood swings are common symptoms of both conditions, and these can be alleviated by medications.
Anti-psychotics can help to ease the hyperarousal that often comes with PTSD, which is where the fight-or-flight response is exaggerated.
In the UK, the antidepressants sertraline and paroxetine are both licensed for treating PTSD, and can simultaneously improve the mood-altering effects of long-term substance use.
Medications can be prescribed on a short-term and long-term basis, and most people find that effects are only noticeable after the first two to four months. Most people are expected to remain on the medication for at least 12 months, with some continuing to take them for many years.
3. Mental Health Therapy
There are various talking therapies that are recommended for addiction treatment and PTSD, with cognitive behavioural therapy (CBT) being the most common.
It has been found to be extremely effective in not only correcting negative behaviours related to substance use but also in examining and repairing negative thought patterns relating to trauma.
Eye movement desensitisation and reprocessing (EMDR) therapy is a similar talking therapy that has been found to be effective in helping to reframe negative emotions following a trauma.
Both of these therapies involve discussing the traumatic event at length, exploring the emotions related to the event, and gradually improving a person’s emotional response when they think about it.
This means that they are better able to handle any triggers or reminders of their trauma, and will be less likely to abuse substances in order to cope.
In cases where the substance use pre-dates PTSD, the factors which lead the person to drink or abuse drugs will be examined first. Once they are understood, the resulting distress can then be worked through.
4. Mutual Support Groups
12-step meetings, like Alcoholics Anonymous, are incredibly popular, both due to their portrayal in the media and their proven efficacy.
Mutual support groups such as these provide a safe, non-judgmental, and confidential environment for people to speak openly about their experiences with substance use and mental health issues.
They give attendees a chance to talk about their trauma in a less structured manner than they would with a therapist, and to also learn from the experiences of other people who are in similar situations.
The groups tend to be free and are located all over the UK, so they are very easy to access.
5. Inpatient Rehabilitation
All of the treatments previously outlined are available to outpatients via the NHS, meaning that they are usually free of charge. Residential, or inpatient, treatment is usually accessed privately, with costs incurred for housing, food, and private therapy.
Not everyone with co-occurring PTSD and substance abuse will need local residential rehab but, similarly, not everyone will have their needs met by outpatient treatment.
Inpatient rehabs tend to offer more niche treatment, and it is possible to find centres that specialise in co-occurring PTSD and substance use disorders.
Accessing experts via the NHS can take a long time, whereas many inpatient treatments are equipped to take you in within a week of your consultation. Inpatient rehab is therefore favoured by those who have reached rock bottom and are in need of immediate help.
References
1: https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/overview/
2: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.8.1184
3: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561398/
4: https://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.html
